tbuckley/cabot-search huggingface dataset:
Utilization, user characteristics, and adverse outcomes of bevacizumab products in oncology in a distributed research network.
Authors: Jenice Ko, Aaron Mendelsohn, Kimberly Daniels, Ainhoa Gomez-Lumbreras, James Marshall, Cara L. McDermott, Pamala A. Pawloski, Gary C. Yee, Catherine Lockhart
Journal: Journal of Clinical Oncology (2022)

400 Background: Bevacizumab (Avastin), an anti-angiogenic agent, was approved for various oncologic indications in 2004 in the US. Two biosimilars, bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), were on the market 2017 and 2019, respectively. Real-world data on adverse events for bevacizumab biosimilars is limited. Methods: We conducted a retrospective cohort study using the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) distributed database to evaluate utilization patterns, patient characteristics, and prespecified adverse events of interest for the originator bevacizumab relative to its biosimilars in oncology among users 21 years of age and older between January 1, 2010, to December 31, 2020. Oncology indications included colon, lung, and gynecologic (cervical, uterine, and ovarian) cancers. Adverse events (AEs) of interest were arterial thromboembolism (ATE), congestive heart failure (CHF), gastrointestinal perforation, stroke and acute myocardial infarction (AMI), and venous thromboembolism (VTE). The study analyzed biosimilars collectively, which include bevacizumab-awwb and bevacizumab-bvzr. Results: Both bevacizumab originator and biosimilar users for colon cancer were mostly male (55%), had a mean age of 61 years, and a mean Charlson/Elixhauser combined comorbidity score from 7.0 to 8.0. Among patients with lung cancer users, 53% were female with an overall mean age of 64 years and comorbidity scores from 6.4 to 7.5. Patients with gynecologic cancers had mean age of 63 years, and comorbidity scores from 6.1 to 6.7. Overall, oncologic bevacizumab use increased by 19% over time. Of the 24,044 total episodes from 2010 to 2020, AEs included ATE (2,560 events, 11%), CHF (2,092 events, 9%), gastrointestinal perforation (2,858 events, 12%), stroke/AMI (399 events, 2%), and VTE (4,447 events, 19%). AE rates were comparable between the originator and biosimilars: 7% and 8% for ATE, 5% and 4% for CHF, 9% and 8% for gastrointestinal perforation, 0.6% and 1% for stroke and AMI, and 10% and 8% for VTE, respectively. From 2019 to 2020, biosimilar use increased from 6% to 49% of total bevacizumab utilization for patients with colon cancer, from 2% to 36% for patients with lung cancer, and from 2% to 38% for patients with gynecologic cancers. Conclusions: Bevacizumab utilization increased across all oncology indications evaluated during the study period. From 2019 to 2020, utilization for biosimilars relative to the originator increased. As there are limited data available on bevacizumab biosimilar use in real world settings, future research should be conducted to see if utilization for biosimilar products continues to rise as well as safety over time.
Behavioral and psychosocial quality improvement project in patients with early-stage breast cancer.
Authors: Vered Stearns, Amanda Montanari, Jennifer Y. Sheng, Janelle Coughlin
Journal: Journal of Clinical Oncology (2022)

361 Background: Cancer treatments often result in unfavorable early and late side effects that impact quality of life. Many forms of cancer, including some types of breast cancer, are also associated with obesity, which may be mediated by lifestyle behaviors. Providing comprehensive cancer treatment and prevention requires assessment and management of both behavioral and psychosocial domains. We initiated a quality improvement project to determine the feasibility of collecting patient-reported outcomes electronically and to identify behavioral and psychosocial needs and interests of women with early stage breast cancer (ESBC) receiving treatment at Johns Hopkins. Methods: We reviewed the outpatient schedules of 2 medical oncologists at different Johns Hopkins sites and identified 169 patients with ESBC who completed a lumpectomy or mastectomy. Using the electronic medical records (EMR) patient portal and/or email, we sent messages to women approximately 3 days prior to an oncology visit with a survey link to a behavioral battery. The battery included assessment of behavioral/psychosocial domains including: nutrition/eating behaviors, weight, pain, substance use, sleep, mental health, sexual health). Women were also asked if they desired additional information on specific behaviors. Results: A total of 100 women responded to the survey (59% response rate). Mean Age = 58.35 years (SD 11.54, range 33-78); 12% Asian, 18% Black, 68% White; 80% married; Mean BMI = 27.8 kg/m2 (SD 6.56). Main results are shown in the table. Behaviors most frequently identified as concerns that patients wanted additional resources for included nutrition (14%) and sleep (11%). Conclusions: Use of the patient portal to gauge patient concerns is feasible, and may help identify the most pressing issues of patients prior to scheduled visits. Our results will be used to develop an EMR-based dashboard and strategies for early interventions to improve wellness and survival outcomes in patients with ESBC.[Table: see text]
Meaningful measures for advanced cancer: Building a measure set to promote goal-concordant care.
Authors: Kristen K. McNiff Landrum, Tom Ross, Corinna Andiel, Keith D. Eaton, Stephen B. Edge, Marina C. George, Joshua Lakin, Denise Morse, Joseph Papio, Wendy Plank, Lauren Thacker, Emily Thompson, Finly Zachariah, Jack Kolosky
Journal: Journal of Clinical Oncology (2022)

210 Background: Research suggests that patients with advanced cancer do not reliably receive care consistent with their goals and values, indicating an important gap. While experts promote measurement of ‘goal concordant care’ this construct is difficult to measure due to definitional and data complexity. The 10 cancer hospitals of the Alliance of Dedicated Cancer Centers (ADCC) have collaboratively implemented interventions to improve goal concordant care and create a wholistic measure set through the Improving Goal Concordant Care (IGCC) Initiative. Methods: ADCC launched the 3 year initiative in 2020. Oncology, palliative care and quality experts completed conceptual work prior to launch including identifying core intervention components, specific aims and potential measures. Following an environmental scan, a workgroup brainstormed relevant measures, then applied feasibility and priority ratings. Patient/family advisors provided guidance. In 2020, a measure panel initiated technical development, using existing specifications as feasible. Claims-based measures were modeled. Following alpha testing, quarterly data submission of selected measures began in 2022. Results: During the conceptual phase, the workgroup identified 60 measures. 19 measures remained following the prioritization and feasibility rating; 14 have been tested and implemented to date (Table). A stakeholder (e.g., patients, physicians, administrators) assessment regarding each measure’s value in assessing quality and usefulness for improvement is in progress. Conclusions: In support of IGCC, we created a set of measures to assess progress towards achieving goal-concordant care. This measure set is intended to be useful in any cancer setting.[Table: see text]
Characterizing and learning from medical malpractice cases against medical oncologists using a national claims database.
Authors: Jim W Doolin, Joseph O. Jacobson, Roy B. Tishler, Adam C Schaffer
Journal: Journal of Clinical Oncology (2022)

318 Background: Malpractice cases may contain valuable information to inform safety improvement efforts in cancer care. No analyses of malpractice cases have been published focusing on medical oncologists as the primary defendant. The recent development of a new safety incident taxonomy for medical oncology enabled us to classify malpractice cases and identify patient safety improvements. 1 . Methods: We conducted a qualitative analysis of case vignettes naming medical oncologists as the primary defendant. Case vignettes were obtained from CRICO’s Candello database. Of 452 cases against medical oncologists, a random sample of 100 cases was selected. Cases were coded for the type of safety incident, and whether a system solution could plausibly reduce the risk of a future event. Coding was performed by 3 physicians with experience caring for patients with cancer. Two reviewers reviewed each case; discrepancies were resolved by the third reviewer. Results: Ninety-nine cases were included in the final analysis; 1 was determined to be misassigned to medical oncology as the primary defendant when the case vignette was entirely about radiation oncology treatment and side effects. The most frequent cancer types were breast (16%), acute leukemia (9%), aggressive lymphoma (8%), and gynecologic malignancies (7%). The most common safety incidents identified were provider clinical management errors (41%), adverse drug reactions (20%), relational issues among providers, patients, and other healthcare staff (13%), and prescriber ordering errors (6%). 47 case vignettes described safety incidents that might have been prevented by a systems intervention. The most common interventions were “tumor board or expert review of rare or uncertain cases” (19%), “pharmacist review for safe prescribing of chemotherapy” (17%), “cancer navigator for appointment scheduling in high-risk settings” (9%), “closed loop communication with radiology” (6%), and “electronic patient portal access to all test results” (6%). Conclusions: Using a new medical oncology-focused incident coding taxonomy, we were able to classify all 99 malpractice cases. Human factors issues accounted for the majority of claims. We determined that more comprehensive use of existing improvement interventions might substantially reduce the risk of future events. 1 Jacobson, J. et al. Development of a taxonomy for characterizing medical oncology-related patient safety and quality incidents: A novel approach. BMJ Open Quality. [Manuscript in press]. Accepted June 10, 2022. DOI 10.1136/bmjoq-2022-001828.R2.
Resource needs screening and matching at an academic oncology center: RESOURCE preliminary results.
Authors: Nadine Jackson McCleary, Ellana K Haakenstad, Bridget A. Neville, Rachel Weitzner, Sunyi Zhang, Michael Manni, Jessica Cleveland, Deborah H Toffler, Julie P Wallace, Michael J. Hassett
Journal: Journal of Clinical Oncology (2022)

178 Background: The social determinants of health contribute to patient (pt) health status throughout the cancer care continuum. Here we describe preliminary results of RESOURCE, a pragmatic intervention to ID and intervene on pt resource needs at an academic oncology center. RESOURCE is an EHR-integrated questionnaire (qst), given when establishing oncology care, that IDs the following needs: transportation; financial, food, &amp; housing security; cost of care; education &amp; employment; and caregiving burden. Pts from an HUP population or reporting resource needs on the cancer center’s intake qst are screened with RESOURCE. Those randomized to the intervention reporting a resource need receive an EHR-mediated referral to internal resource specialist and financial assistance teams. Methods: All adult cancer pts may complete the EHR-integrated intake qst. We compared historic rates of reported vulnerability from the intake qst with resource needs reported in RESOURCE. Intake qst data from 6/2015 – 4/2022 included 21,343 respondents with data on financial security, social isolation, health literacy, and health numeracy. RESOURCE data from 6/2021 – 6/2022 on the domains above included 75 respondents (125 will be accrued in total; no conditions will end accrual early). The intake qst is available for all adult cancer pts (response rate 24%; RESOURCE response rate of 87%). and The following were compared with χ 2 tests: the demographic profile of each pt population; and the proportion of respondents with any one need ID'd by RESOURCE vs the intake qst. These preliminary results allow us to determine if we may prepare to scale RESOURCE upon the study’s completion. Results: The enriched pt population of RESOURCE means that there is a statistically significant difference in demographics between the general pt population responding to the intake qst and the RESOURCE pts responding to the RESOURCE by each category (p-values &lt; 0.01). A higher proportion of pts identified a need on the intake qst (61%) than on RESOURCE (41%). RESOURCE pts most commonly reported the following needs: paying utility bills (24%), food security (20%), and cost of care (19%). Conclusions: While a larger proportion of pts reported a resource need on the intake qst, the RESOURCE qst had a far superior response rate; this discrepancy makes it difficult to determine which qst is better at determining resource needs. The RESOURCE qst allows us to see the type of need in greater detail. Collecting this data systematically allows us to quantify the resource needs of our pts so we can provide adequate support staff and resources.[Table: see text]
Associations of delays in care due to transportation barriers and care utilization, and cause-specific mortality risk among the U.S. adults with a cancer history.
Authors: Changchuan Jiang, Lei Deng, Stuthi Perimbeti, Qian Wang, K. Robin Robin Yabroff, Xuesong Han
Journal: Journal of Clinical Oncology (2022)

70 Background: Cancer survivors have greater comorbidity burden, health care use, and mortality risk than individuals without a cancer history. Cancer survivors are also more likely to experience transportation barriers to care in the US. This study examines associations between transportation barriers and cancer survivors' care utilization and outcomes in a nationally representative sample. Methods: We identified cohorts of cancer survivors (n = 28,606) and adults without a cancer history (n = 469,860) from the 2000-2018 National Health Interview Survey (NHIS) linked to the recently released NHIS Mortality Files. Transportation barriers were measured as medical care delays during the past 12 months due to lack of transportation. Outcomes included lack of routine place for care, emergency room (ER) use during the past 12 months, all-cause, and cancer-specific mortality. Their association with transportation barriers was estimated using weighted multivariable logistic, and Cox’s proportional hazards regressions, respectively. Models were adjusted for age, sex, race, educational attainment, comorbidities, region, year of survey, and functional limitations, as well as time since cancer diagnosis, and cancer types (breast, colorectal, prostate, and others). Health insurance coverage was added sequentially to models. Results: 2.8% of cancer survivors and 1.7% of adults without cancer history reported delays in care due to transportation barriers. Cancer survivors with transportation barriers had the strongest associations with lack of routine place for care and ER use; followed by survivors without transportation barriers; and adults without a cancer history with and without transportation barriers (Table). Similarly, transportation barriers were associated with the highest risk of all-cause and cancer-specific mortality risk among cancer survivors. Further adjustment for health insurance reduced the magnitude of association between transportation barriers and mortality. Conclusions: Cancer survivors who delayed care due to lack of transportation were more likely to use the ER. They also had the highest risks of all-cause and cancer-specific mortality. Efforts are needed to mitigate transportation barriers in the rapidly growing but vulnerable cancer survivor community.[Table: see text]
Time of clinic appointment and advance care planning discussions in oncology.
Authors: Likhitha Kolla, Jinbo Chen, Ravi Bharat Parikh
Journal: Journal of Clinical Oncology (2022)

185 Background: Early advance care planning (ACP) in oncology increases goal-concordant care. However, time pressures during a busy clinic day may prevent clinicians from engaging in necessary conversations. Given prior evidence of suboptimal clinician decision-making in non-oncology settings in latter parts of a clinic day, we investigated the association between appointment time and likelihood of ACP conversations. Methods: We used electronic health record data to identify medical oncology encounters. We ascertained the presence of ACP from either (1) a specific ACP note type in the EHR, or (2) an ACP smart phrase in clinical progress notes. ACP documentation was used as a surrogate for ACP discussions, as ACP documentation is a quality metric used by organizations including the ASCO’s Quality Oncology Practice Initiative. Appointment times between 8am and 4pm were separated by the hour. Oncology clinicians usually practiced in a morning (8am to 11am) or afternoon (12pm to 4pm) session. Time was indicated by grouping appointment times in the order they occur in a session. We used generalized estimating equations, clustering by clinician, to estimate the probability of ACP documentation. Session hour (1-5) was included as a categorical and continuous variable. We adjusted for patient clinical and demographic features. We also performed a sensitivity analysis using a restricted sample that excluded encounters from 12pm. Results: Adjusted odds ratios (ORs) for ACP documentation rates were significantly lower for all hours of a session after the earliest hour (Table), with consistent results in the sensitivity analysis. Conclusions: Oncology clinicians’ likelihood of having advance care planning conversations decreases as a clinic session progresses. Decision fatigue and falling behind schedule could be contributing reasons for this effect. Lower rates of discussions about goals of care later in a session could result in more aggressive end-of-life treatments. Proactive scheduling of high-risk patients earlier in a clinic session or scheduling separate visits for advance care planning could facilitate necessary conversations and should be further studied.[Table: see text]
APPs provide high-quality specialty care in virtual clinic.
Authors: Sara Toth, Christine L Long, Sydney Townsend, Sabrina Q. Mikan, Blake Hoegger, Debra A. Patt, Holly Books
Journal: Journal of Clinical Oncology (2022)

390 Background: In our team-based approach to care delivery, Advanced Practice Providers (APPs) are a critical component of the care delivery team. In our statewide oncology practice APPs are not available at each site, limiting our ability to provide program visits that enhance patient care and limiting our flexible staffing capacity. APP program visits - Advance Care Planning (ACP), Treatment Review and Coordination (TRC) and Genetics – had limited availability due to the capacity of existing APP staff. We sought to provide both enhancements in patient care with program visits and offer flexible staffing capacity across our statewide practice by using a centralized virtual care clinic model providing high quality specialty care via Telemedicine. Methods: Four APPs were identified and trained to provide full-time telemedicine services statewide under a single collaboration agreement with the Virtual APP Medical Director. Local sites went through a brief onboarding process with the Virtual APP clinic and then submitted requests for appointment coverage by the Virtual APP (VAPP) team. The VAPPs had the same core oncology training, with a few differentiated skills which were matched with coverage requests aligning with their skill sets. To ensure continuity of care, virtual APP clinic notes were visible statewide in the practice EHR, and local providers were alerted by chart message of significant patient concerns. Results: In the first 3 months of service, the VAPPs completed 1,040 appointments for 12 clinics. The VAPPs conducted 50% Program visits and 50% established patient visits (follow-up, on treatment and urgent care). Conducting the Program visits virtually allowed patients to invite family members from any location to join the appointments virtually. The Urgent Care capability was not used frequently in the first 90 days of service, but may still grow in the future. Conclusions: The Virtual APP program ensured oncology patients received high quality, timely care through 1,040 completed visits. This prevented delays in care, resolved staffing challenges, expanded care, and supports virtual care in oncology. This program ensures APPs are available when and where needed and allows them to efficiently serve multiple clinics. The VAPPs provided education, assessment, prevention, and management of toxicities in a flexible manner.
Who is most satisfied with their experience? A systematic approach to an equitable patient experience.
Authors: Caitlin C Donohue, Kelly Eng, Maria Ferzoco, Sarah Kadish, Magnolia Contreras, Andrew J. Wagner, William C. Hahn, Christopher S. Lathan
Journal: Journal of Clinical Oncology (2022)

265 Background: In 2019, Dana-Farber Cancer Institute (DFCI) conducted exploratory quantitative analyses of patient satisfaction scores stratified by demographics to understand where gaps in experience exist. Results suggested differences among certain groups. As such, we applied a broad, systematic approach to our patient experience understanding to prioritize and implement improvements. Methods: A multidisciplinary team conducted an analysis of patient experience using a phased mixed method approach to identify areas for improvement. First, the team analyzed ̃50,000 patient experience surveys (Mar 2019-Feb 2021). Surveys were collected from all DFCI-sites and stratified by race, ethnicity, and language. Significance testing was conducted using z-tests. Second, results of the quantitative analysis were used to define focus group participant demographics and interview questions. Results: The analysis found demographic differences in response rates (White 25.5%, n = 24,519; Black 14.0%, n = 567; Asian 14.7%, n = 495; Hispanic or Latino 11.6%, n = 92; English 25.1%, n = 25,074; Non-English 11.2%, n = 332) and lower top box satisfaction scores (% patients rating in highest category) for patients of color and patients whose preferred language is not English (Table). Table shows results from a survey question asking patients to rate overall quality of care received at the facility. Next, DFCI will conduct fourteen focus groups with diverse patient groups to learn where DFCI has improvement opportunities. Focus groups will include English-speaking Black, Indigenous, Patients of Color as well as Spanish, Arabic, Mandarin, and Cantonese speaking patients. Following focus groups, a thematic analysis will be conducted, and recommendations will be prioritized and implemented by multidisciplinary teams. Conclusions: Patient experience survey data are typically reported in aggregate, masking variation among the demographic groupings in which patients identify. Using a systematic approach, stratifying the data specifically to understand where differences exist, was fundamental to understanding gaps in experience among separate groups of patients. This granular knowledge is critical to providing an equitable patient experience and is the necessary approach that will allow us to identify and prioritize interventions to improve the patient experience for all. Through our approach, we aim to elevate voices of patients across demographic groups and to inform the health delivery interventions needed.[Table: see text]